Sustiva and Suicide: Don't Be Scared, but Be Aware

Mental health really matters in HIV. We got a hugely important reminder of that this month in the form of new research regarding suicide and Sustiva (also known as Stocrin or efavirenz; part of the fixed-dose combination pill Atripla).

The research was an examination of four major studies involving Sustiva conducted between 2000 and 2010. It found that HIV-positive study volunteers who took Sustiva as part of their treatment regimen were about twice as likely to have suicidal thoughts or attempt suicide as volunteers who weren't taking Sustiva.

The overall number of suicides was very low: 5,332 people volunteered for these studies, each of which spanned at least two years, and the main data analysis found that 22 of the volunteers attempted suicide. (About two-thirds of them were taking Sustiva.) And don't forget that, generally speaking, HIV treatment appears to reduce suicide risk.

The difference in suicide rates between people on Sustiva and people not on Sustiva didn't really begin to emerge until more than a year after they started treatment. So whatever the effect may be of Sustiva on severe depression, it's extremely unlikely to be immediate; there will more likely be signs of danger over a long period of time.

In these studies, the people who attempted suicide, or who had suicidal thoughts, tended to already have other risk factors for depression or mental illness: They were disproportionately young (less than 30), more likely to have a history of injection drug use and much more likely to have a history of psychiatric issues or be on psychoactive medications (like anti-anxiety meds or antidepressants).

The upshot to all of this comes down to two words: be vigilant. This is alarming news, certainly, and it may well be grounds for second-guessing a decision to take Sustiva (or Atripla, which is the most commonly prescribed first-line HIV medication in the U.S.) if a person already has some of the risk factors mentioned above. But again, actual incidents of suicidal thoughts or suicide attempts were still very low in these studies, so there's little cause for immediate alarm.

What's important is that people living with HIV and their care providers be keenly aware of the possible effects of Sustiva on the brain. The drug's potential to mess with a person's sleep habits, ability to concentrate, anxiety levels and other behavioral issues are well documented at this point, so HIV-positive people and care providers alike should already be closely paying attention to mental health and ensuring that people on Sustiva get any psychological or psychiatric help they may need. These findings only further drive home just how important it is to be aware.

Mental health has always been a key part of physical health. By the same token, HIV care and mental health care must go hand-in-hand. The relationship between Sustiva and suicide make clear how critical that is.